Trends in Prices of Popular Brand-Name Prescription Drugs in the United States

Key Points

Question

What are the prices of top-selling brand-name prescription drugs in the United States, and how have these prices changed in recent years?

Findings

In this economic evaluation of 49 common top-selling brand-name drugs, 78% of the drugs that have been available since 2012 have seen an increase in insurer and out-of-pocket costs by more than 50%, and 44% have more than doubled in price.

Meaning

Prices of brand-name drugs in the United States are likely to continue to increase, which warrants greater price transparency.

Abstract

Importance

High and continually increasing pharmaceutical drug spending is a major health and health policy concern in the United States.

Objective

To demonstrate trends in prices among popular brand-name prescription drugs.

Design, Setting, and Participants

This economic evaluation of drug prices focuses on 49 top-selling brand-name medications in the United States. Pharmacy claims data from January 1, 2012, through December 31, 2017, were obtained from Blue Cross Blue Shield Axis, a database that includes data from more than 35 million individuals with private pharmaceutical insurance. Drugs that exceeded $500 million in US sales or $1 billion in worldwide sales were examined.

Main Outcomes and Measures

The median sum of out-of-pocket and insurance costs paid by patients or insurers for common prescriptions, presented annually and monthly, was the primary outcome.

Results

In total, 132 brand-name prescription drugs were identified in 2017 that met the inclusion criteria. Of this total, the study focused on 49 top-selling drugs that exceeded 100 000 pharmacy claims. Substantial cost increases among these drugs was near universal, with a 76% median cost increase from January 2012 through December 2017, and almost all drugs (48 [98%]) displaying regular annual or biannual price increases. Of the 36 drugs that have been available since 2012, 28 (78%) have seen an increase in insurer and out-of-pocket costs by more than 50%, and 16 (44%) have more than doubled in price. Insulins (ie, Novolog, Humalog, and Lantus) and tumor necrosis factor inhibitors (ie, Humira and Enbrel) demonstrated highly correlated price increases, coinciding with some of the largest growth in drug costs. Relative price changes did not differ between drugs that entered the market in the past 3 to 6 years and those that have been on the market longer (number of drugs, 13 vs 36; median, 29% increase from January 2015 through December 2017; P = .81) nor between drugs with or without a Food and Drug Administration–approved therapeutic equivalent (number of drugs, 17 vs 32; median, 79% vs 73%; P = .21). Changes in prices paid were highly correlated with third-party estimates of changes in drug net prices (ρ = 0.55; P = 3.8 × 10 ⁻⁵), suggesting that the current rebate system, which incentivizes high list prices and greater reliance on rebates, increases overall costs.

Conclusions and Relevance

The growth of drug spending in the United States associated with government-protected market exclusivity is likely to continue; greater price transparency is warranted.

Abstract

This economic evaluation study uses pharmaceutical insurance claims data to report the consistent rise in prices of commonly used prescription medicines in the United States.